Hollow bulb obturator and implant retained mandibular overdenture for a compromised completely edentulous patient with partial maxillectomy

Harmanpreet Atwal,Anup Gopi,Rajesh Kumar Yadav,Tanuj Mendiratta

doi:10.18231/j.ijohd.2020.045

Abstract

A large maxillary defect situation is often challenging in terms of prosthetic rehabilitation considering the lack of retention, facial support and limited mouth opening along with psychological and functional trauma to the patient. In such situations we aim to successfully rehabilitate the defect in terms of function and aesthetics while ensuring complete obturation of the defect. A 65 years old female with maxillary surgical defect of right side due to squamous cell carcinoma resection along with associated limited mouth opening and post surgical scar contracture reported for prosthetic rehabilitation. This paper describes in detail an unconventional method for the fabrication of a modified hollow bulb obturator with an implant retained mandibular overdenture with monoplane occlusion and balancing ramps. This not only closed the oro-antral communication but also enhanced the masticatory performance, speech and psychological status of the patient. Decreased weight of the prosthesis and an implant retained mandibular overdenture with monoplane occlusion and balancing ramps improved retention, stability and support of the prosthesis, thereby, improving the quality of life after extensive maxillectomy.

Highlights

Obturator for a large maxillary defect presents a challenge due to its undesirable weight which reduces the retention, stability and support of the maxillofacial prosthesis leading to loss of peripheral seal and traumatic functional occlusion
Variety of methods have been described in the literature to fabricate closed hollow bulb obturator, out of which most of the techniques describe the incorporation of various heat labile materials during packing stage or by doing multiple processing or making two piece components and later sealing them to make it a hollow prosthesis
Numerous techniques are available in the literature for fabrication of closed or open type of hollow bulb obturator. 5,6 Worley and Kniejski described a method for the fabrication of a closed hollow obturator while maintaining uniform thickness of the surrounding wall around the hollow portion

Summary

Introduction

Obturator for a large maxillary defect presents a challenge due to its undesirable weight which reduces the retention, stability and support of the maxillofacial prosthesis leading to loss of peripheral seal and traumatic functional occlusion. 1. Wu YL and Schaaf designed different types of obturator prostheses (both solid and hollow) which were evaluated for the amount of weight reduction. Wu YL and Schaaf designed different types of obturator prostheses (both solid and hollow) which were evaluated for the amount of weight reduction They concluded that there was a significant weight reduction in hollow obturator prosthesis, from 6.55% to 33.06% which in turn depends on the size of the defect. 3. Variety of methods have been described in the literature to fabricate closed hollow bulb obturator, out of which most of the techniques describe the incorporation of various heat labile materials during packing stage or by doing multiple processing or making two piece components and later sealing them to make it a hollow prosthesis.

Objectives

Methods

Conclusion